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INCOME RECEIPT
MINISTRY OF FINANCE OF RI PERIOD [mm - mm]
DIRECTORATE GENERAL OF TAXES NO : H.01 1 . 1 - . - H.02 -
TIN OF
WITHHOLDER : H.03
- .
NAME OF
WITHHOLDER : H.04
ID NO/ M/ S/ HB /
2. PASSPORT
NO. : A.02 A.07 A.08 A.09
GROSS INCOME :
1. SALARY/PENSION/RETIREMENT ALLOWANCE
6. INCOME IN THE FORM OF BENEFIT IN KIND OR OTHER WHICH WITHHELD BY INCOME TAX ART. 21
DEDUCTION :
14. TOTAL NET INCOME FOR INCOME TAX ART 21 CALCULATION (ANNUAL / ANNUALIZED)
18. INCOME TAX ART. 21 WHICH ALREADY WITHHELD IN THE PREVIOUS PERIOD
20. INCOME TAX ART 21 AND ART 26 WHICH ALREADY BEEN WITHHELD AND SETTLED
C. IDENTITY OF WITHHOLDER